Provider Demographics
NPI:1467648014
Name:CLEVELAND VASCULAR SURG ASOC
Entity Type:Organization
Organization Name:CLEVELAND VASCULAR SURG ASOC
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BASEM
Authorized Official - Middle Name:
Authorized Official - Last Name:DROUBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-356-1009
Mailing Address - Street 1:20997 LORAIN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-2030
Mailing Address - Country:US
Mailing Address - Phone:440-356-1009
Mailing Address - Fax:
Practice Address - Street 1:20997 LORAIN RD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-2030
Practice Address - Country:US
Practice Address - Phone:440-356-1009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35040353174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0963533Medicaid
OHCL9933371Medicare PIN
OH0963533Medicaid